Quebec move to legalize euthanasia pits ethics professor against former student in debate over death

How We Die Now: Euthanasia raises intense ethical and legal questions

How We Die Now: “Death renders all equal,” wrote Claudian. How each one of us relates to death, however, is individual, and always changing — as we mature; as we contemplate life, and death, around us; and as society changes. In this special series in the National Post, we present stories and columns looking at the different ways we see, and prepare for, the Great Equalizer. To read the complete series, click here.

MONTREAL – When Véronique Hivon was a law student at McGill University in the early 1990s, she studied under the renowned ethicist Margaret Somerville. It was a time of intense national debate over doctor-aided death, sparked by Sue Rodriguez’s unsuccessful battle for assisted suicide to end her suffering from a degenerative nerve disease. Ms. Hivon supported Ms. Rodriguez’s position while Prof. Somerville made no secret of her opposition.

Fast forward two decades to last Oct. 9, and the former student and professor were together again, this time in a committee hearing room at Quebec’s National Assembly. Canadian law has not changed since Ms. Rodriguez lost her case, but Ms. Hivon is doing her best to change that. As Quebec’s junior health minister she is the driving force behind legislation that would legalize euthanasia in the province.

“I said to her, ‘I didn’t teach you very well,’ ” Prof. Somerville recalled after testifying before Ms. Hivon and other members of a committee studying Bill 52 — An Act Respecting End-of-life Care. For her part, Ms. Hivon said she told her former professor “that she probably thought I didn’t turn out the way she hoped I would.”

Prof. Somerville, founding director of McGill’s Centre for Medicine, Ethics and Law, told the committee that the proposed legislation represents “a radical change in our shared values regarding respect for human life.” She said euthanasia raises a basic question: “Is it wrong for one person to intentionally kill another? I believe that it is.” But just as her lectures of two decades ago did not sway the young law student, Prof. Somerville’s entreaties against Bill 52 seem destined to fail.

With support from all parties, Ms. Hivon is hopeful the project she began pushing four years ago will become law before the legislature adjourns in December. If passed, the bill would make history in Canada, allowing physicians to deliberately end patients’ lives.

In order to qualify, a patient would have to request euthanasia in writing and meet four criteria:

Be 18 years old and capable of giving consent;

Suffer from an incurable illness;

Be in an advanced state of irreversible decline in capability; and

Suffer from constant and unbearable physical or psychological pain that cannot be relieved.

Once a physician determined that all conditions had been met for a lethal injection and obtained approval from a second doctor, the bill says, “the physician must administer such aid personally and take care of the patient until their death.”

Nothing Ms. Hivon heard from various interest groups during hearings that concluded this month has changed her mind on the need for euthanasia.

“Of course, it’s not unanimous, but I think it’s broadly consensual. It confirms the fact that our approach, which is one of a global, very integrated approach to end-of-life care is the right one,” she said in an interview.

An Environics Institute poll released this month found Quebecers are more likely than other Canadians to support doctor-assisted death. The poll found that nearly four in five Quebecers – 79% — said they approved of euthanasia, defined by the pollster as “allowing a terminally ill or severely disabled person to end their life.” Nationally, the approval rate was 69%.

During the committee hearings, professional groups representing Quebec physicians, nurses, and pharmacists all came out in favour of the legislation. The Quebec bar association, representing the province’s lawyers, called the bill “a major advance for the dignity and self-determination of persons at the end of life.”

But one party that will have an important say in Bill 52’s ultimate fate, the federal government, is keeping its cards close to its chest. Quebec is asserting jurisdiction over euthanasia on the grounds that it is a medical act, and health is a provincial jurisdiction. That argument skirts the problem posed by the Criminal Code, federal law that states, “no person is entitled to consent to have death inflicted on him.” Receiving such consent does not shield someone inflicting death – a doctor, for example – from criminal prosecution for homicide.

After euthanasia was thrust back into the national political arena this month by the posthumous release of Dr. Donald Low’s video appeal for physician-assisted death, federal Health Minister Rona Ambrose called the euthanasia debate “an important conversation to have” and said she would discuss the topic with her provincial counterparts. Federal Justice Minister Peter MacKay, however, said through an aide that the government feels that the debate is closed and that existing Criminal Code provisions prohibiting doctors from assisting in death are constitutionally sound.

Ms. Hivon interprets Ottawa’s stance to mean it is prepared to let provinces take the initiative. “We’re really confident about our jurisdictional legal basis, because the whole approach is really based on our jurisdiction over health,” she said. “It’s not assisted suicide. It’s really a continuum of care that has to involve, for some exceptional circumstances, a care that is not possible right now.” But just in case some physicians are spooked that this new care – deliberately ending a patient’s life – could land them in jail, the justice minister is looking at instructing Crown prosecutors not to lay charges against physicians who follow the guidelines laid out in Bill 52. Ms. Hivon called the instructions “a belt-and-suspenders approach.”

‘It’s not assisted suicide. It’s really a continuum of care’

Still, the federal government would face pressure from euthanasia opponents to intervene. The Evangelical Fellowship of Canada published an analysis of Bill 52 this month concluding it would be in clear conflict with the Criminal Code and would likely lead to a court challenge. “If the government of Quebec proceeds with this initiative, it may well be perceived as provoking a response from the federal government which, within its constitutional and Supreme Court of Canada-affirmed authority over Canada’s criminal laws, has determined euthanasia is illegal,” Don Hutchinson, the Fellowship’s vice-president and general counsel, said.

Prof. Somerville noted that the fading of the Church’s influence in Quebec has left a void. “In a religious society, religion is the main carrier of the shared societal value of respect for life. In a secular society you can’t do that, you can’t use religion to carry your main value,” she said.

“So which are the main institutions that carry the value of respect for life. They are the law and medicine. And what does euthanasia do? It says let’s change the law to let doctors kill their patients.”

For Ms. Hivon, the idea that doctors will be transformed into killers is a gross exaggeration. “The very vast majority of people will never want to have medical aid in dying. People want to live. That is the biggest, most important safeguard,” she said. “But for this very small minority of people who cannot find answers to their suffering at the end of life, what do we do as a society that believes in solidarity and compassion? This part of the bill about medical aid in dying is really an exceptional answer to exceptional circumstances of exceptional suffering that cannot be alleviated.”

The disagreement remains the same, but unlike the days when Prof. Somerville was grading her papers, it is now Ms. Hivon who holds the upper hand.

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